Saturday, February 18, 2017

MRI in the ED

emDocs - February 17, 2017 - Author: Long A -  Edited by: Koyfman A and Long B
"Bottom line:
An MRI should only be ordered in the ED when the patient’s treatment and/or management will be affected.
The misuse of MRIs in the ED generates unnecessary costs to patients and increased time in the department. It is essential to weigh the risk(s) of ordering an MRI for your patient in the ED.
The indications for emergency MRI Brain include clinical concern for acute ischemic stroke, particularly wherein the management may differ with possible intervention versus less aggressive treatment plans.If there is clinical concern for new spinal cord compression from disease or injury, an emergency MRI evaluation is necessary. 
The indications for emergency spinal MRI include suspicion for:
  • Spinal cord compression (herniated disc, burst fracture, tumors, etc)
  • Spinal infection (i.e. abscess)
  • Spinal trauma (epidural hemorrhage, etc)
  • Demyelination with acute neurologic changes
Additionally, emergency MRIs may be considered if there is concern for:
  • Appendicitis in the pregnant or pediatric patient
  • Hip fracture not detected on plain film or CT"